New York Medicaid New Resource Documentation Rules

by David Goldfarb Goldfarb Abrandt Salzman & Kutzin LLP

There are three distinct resource documentation requirements depending on the type of Medicaid applied for. The three types of Medicaid coverage and the resource documentation requirements are: (1) Community Coverage Without Long-Term Care – requires a self-attestation to the amount of current resources; (2) Community Coverage With Community-Based Long-Term Care – requires proof of current resources; or (3) Medicaid coverage of all covered care and services (including nursing facility services)- requires a resource review for the past 36 months (60 months for trusts). N.Y. Soc Serv. Law § 366-a; 04 OMM/ADM-6 (July 20, 2004).

Community Coverage Without Long-Term Care

If an applicant is applying for Medicaid services without any long term care services, either institutional care or community based home care, then the applicant may attest to her resources and not supply any further documentation. N.Y. Soc. Serv. Law § 366-a (2)(b); N.Y. Comp. Codes R. & Regs. tit. 18 § 360-2.3(c)(3); 04 OMM/ADM-6 (July 20, 2004).

An applicant must provide documentation of any trust agreement in which she is the creator or beneficiary. An applicant must provide any pre-need funeral agreement.

A recipient of Community Coverage Without Long-Term Care, nevertheless qualifies for 29 consecutive days of certified home health care and rehabilitative nursing home care in any 12-month period.

Community Coverage With Community-Based Long-Term Care

If an applicant is applying for Community Coverage With Community-Based Long-Term Care she must provide documentation only of current resources. Community Coverage With Community-Based Long-Term Care includes all Medicaid covered care and services except nursing home care. It does, however, include short-term rehabilitative nursing home care. 04 OMM/ADM-6 (July 20, 2004).

A recipient of Community Coverage With Community-Based Long-Term Care, nevertheless qualifies for 29 consecutive days of certified home health care and rehabilitative nursing home care in any 12-month period.

Medicaid Coverage for All Covered Care and Services

If an applicant is applying for Medicaid Coverage for All Covered Care and Services she must provide documentation of her resources for the past 36-month (or 60 months for trusts).

Short-Term Rehabilitation Services

A recipient of Community Coverage With or Without Community-Based Long-Term Care, nevertheless qualifies for 29 consecutive days of certified home health care (CHHA services) and rehabilitative nursing home care in any 12-month period. The entitlement is for only one commencement/admission in a 12-month period of certified home health care and of nursing home care. Each commencement/admission can be for up to 29 days. 04 OMM/ADM-6 (July 20, 2004).